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Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

OKLAHOMA CENTER FOR ORTHOPAEDIC & MULTI-SP

Oklahoma City, OK · CCN 370212 · Rates published

Your selected procedure

You selected 29916 (CPT)

ARTHROSCOPY HIP SURGICAL W/REMOVAL OF LOOSE BODY W/LABRAL REPAIR 29916

This hospital’s price: $1,750 across 5 payers · range $450-$13,461

Source: https://mrfs.hyvehealthcare.com/USPI/731623669_oklahoma-center-for-orthopedic-&-multi-specialty-surgery_standardcharges.json · observed 2026-04-14

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

10,884 distinct procedures filed
6 distinct payers
140,363 rate rows
2026-04-14 last MRF observed
Data quality

101,460 of 140,363 rate rows are consumer-grade (72.3%)

38,903 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 28,417
template filing: same amount across many unrelated codes — excluded 9,758
exceeds 10× this hospital's gross charge — excluded from medians 353
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 313
per-diem day rate — not a per-procedure price 62
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://mrfs.hyvehealthcare.com/USPI/731623669_oklahoma-center-for-orthopedic-&-multi-specialty-surgery_standardcharges.json
Found on page https://ocomhospital.com/cms-hpt.txt
Discovered viaCMS hospital list
Last fetch not_modified · 2026-10-11
Content fingerprint 7aa3ec8d0307afbf… · 31,686,735 bytes · first seen 2026-05-17

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
77371
CPT 		Srs Multisource 2 $5,454.00 $41,468.00 $38,250.00 nat. median
$9,444
outlier · 4.1×
228
MS_DRG 		Other Cardiothoracic Procedures With Mcc 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$47,347
0.7× median
224
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$39,601
0.8× median
232
MS_DRG 		Coronary Bypass With Ptca Without Mcc 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$57,798
0.6× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$90,512
outlier · 0.4×
227
MS_DRG 		Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$31,634
1.1× median
226
MS_DRG 		Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$38,225
0.9× median
217
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$61,995
0.5× median
221
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$46,440
0.7× median
229
MS_DRG 		Other Cardiothoracic Procedures Without Mcc 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$30,744
1.1× median
225
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$34,024
1.0× median
215
MS_DRG 		Other Heart Assist System Implant 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$93,787
outlier · 0.4×
219
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$72,247
outlier · 0.5×
220
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$50,558
0.7× median
223
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$32,619
1.0× median
218
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$59,493
0.6× median
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$76,979
outlier · 0.4×
222
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$47,543
0.7× median
77372
CPT 		Srs Linear Based 3 $1,237.38 $41,468.00 $21,852.00 nat. median
$9,194
outlier · 2.4×
249
MS_DRG 		Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent Without Mcc 1 $14,485.00 $14,485.00 $14,485.00 nat. median
$11,561
1.3× median
253
MS_DRG 		Other Vascular Procedures With Cc 1 $14,485.00 $14,485.00 $14,485.00 nat. median
$24,911
0.6× median
247
MS_DRG 		Percutaneous Cardiovascular Procedures With Drug-eluting Stent Without Mcc 1 $14,485.00 $14,485.00 $14,485.00 nat. median
$12,886
1.1× median
254
MS_DRG 		Other Vascular Procedures Without Cc/mcc 1 $14,485.00 $14,485.00 $14,485.00 nat. median
$17,476
0.8× median
246
MS_DRG 		Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar… 1 $14,485.00 $14,485.00 $14,485.00 nat. median
$20,454
0.7× median
244
MS_DRG 		Permanent Cardiac Pacemaker Implant Without Cc/mcc 1 $14,485.00 $14,485.00 $14,485.00 nat. median
$17,977
0.8× median
243
MS_DRG 		Permanent Cardiac Pacemaker Implant With Cc 1 $14,485.00 $14,485.00 $14,485.00 nat. median
$21,235
0.7× median
242
MS_DRG 		Permanent Cardiac Pacemaker Implant With Mcc 1 $14,485.00 $14,485.00 $14,485.00 nat. median
$30,977
outlier · 0.5×
248
MS_DRG 		Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent With Mcc Or 4… 1 $14,485.00 $14,485.00 $14,485.00 nat. median
$18,397
0.8× median
C9770
HCPCS 		Vitrec/mech Pars, Subret Inj 1 $13,461.00 $13,461.00 $13,461.00 nat. median
$4,792
outlier · 2.8×
C9771
HCPCS 		Nsl/sins Cryo Post Nasal Tis 1 $13,461.00 $13,461.00 $13,461.00 nat. median
$3,428
outlier · 3.9×
788
MS_DRG 		Cesarean Section Without Sterilization Without Cc/mcc 1 $12,053.00 $12,053.00 $12,053.00 nat. median
$9,598
1.3× median
786
MS_DRG 		Cesarean Section Without Sterilization With Mcc 1 $12,053.00 $12,053.00 $12,053.00 nat. median
$14,836
0.8× median
787
MS_DRG 		Cesarean Section Without Sterilization With Cc 1 $12,053.00 $12,053.00 $12,053.00 nat. median
$10,903
1.1× median
785
MS_DRG 		Cesarean Section With Sterilization Without Cc/mcc 1 $12,053.00 $12,053.00 $12,053.00 nat. median
$9,457
1.3× median
783
MS_DRG 		Cesarean Section With Sterilization With Mcc 1 $12,053.00 $12,053.00 $12,053.00 nat. median
$18,753
0.6× median
784
MS_DRG 		Cesarean Section With Sterilization With Cc 1 $12,053.00 $12,053.00 $12,053.00 nat. median
$10,574
1.1× median
419
MS_DRG 		Laparoscopic Cholecystectomy Without C.d.e. Without Cc/mcc 1 $10,715.00 $10,715.00 $10,715.00 nat. median
$13,549
0.8× median
418
MS_DRG 		Laparoscopic Cholecystectomy Without C.d.e. With Cc 1 $10,715.00 $10,715.00 $10,715.00 nat. median
$16,451
0.7× median
417
MS_DRG 		Laparoscopic Cholecystectomy Without C.d.e. With Mcc 1 $10,715.00 $10,715.00 $10,715.00 nat. median
$22,548
outlier · 0.5×
286
MS_DRG 		Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc 1 $8,385.00 $8,385.00 $8,385.00 nat. median
$20,800
outlier · 0.4×
287
MS_DRG 		Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc 1 $8,385.00 $8,385.00 $8,385.00 nat. median
$11,240
0.7× median
81416
CPT 		Exome Sequence Analysis 2 $5,454.00 $10,800.00 $8,127.00 nat. median
$12,000
0.7× median
C7562
HCPCS 		Catheter Placement In Coronary Artery(s) For Coronary Angiography, Including Int… 1 $6,016.00 $9,621.00 $7,818.50 nat. median
$5,297
1.5× median
C8005
HCPCS 		Bronchoscopy, Rigid Or Flexible, Non-thermal Transbronchial Ablation Of Lesion(s… 1 $5,511.00 $8,814.00 $7,162.50 nat. median
$17,500
outlier · 0.4×
913T
OTHER 		Percutaneous Transcatheter Therapeutic Drug Delivery By Intracoronary Drug-deliv… 1 $5,511.00 $8,814.00 $7,162.50 nat. median
$6,882
1.0× median
915T
OTHER 		Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co… 1 $5,511.00 $8,814.00 $7,162.50 nat. median
$32,922
outlier · 0.2×
C7563
HCPCS 		Transluminal Balloon Angioplasty (except Lower Extremity Artery(ies) For Occlusi… 1 $5,511.00 $8,814.00 $7,162.50 nat. median
$5,702
1.3× median
933T
OTHER 		Transcatheter Implantation Of Wireless Left Atrial Pressure Sensor For Long-term… 1 $5,511.00 $8,814.00 $7,162.50 nat. median
$4,716
1.5× median
C7564
HCPCS 		Percutaneous Transluminal Mechanical Thrombectomy, Vein(s), Including Intraproce… 1 $5,511.00 $8,814.00 $7,162.50 nat. median
$5,650
1.3× median
36837
CPT 		Prq Av Fstl Crt Uxtr Sep Acs 3 $5,454.00 $8,814.00 $6,905.50 nat. median
$17,365
outlier · 0.4×

Other procedures at this hospital

Browse this hospital's 10,884 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
77371 CPT Srs Multisource 3 2 — — $5,454.00 $41,468.00 $38,250.00 2026-04-14
228 MS_DRG Other Cardiothoracic Procedures With Mcc 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
232 MS_DRG Coronary Bypass With Ptca Without Mcc 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
215 MS_DRG Other Heart Assist System Implant 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
231 MS_DRG Coronary Bypass With Ptca With Mcc 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
77372 CPT Srs Linear Based 4 3 — — $1,237.38 $41,468.00 $21,852.00 2026-04-14
249 MS_DRG Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent Without Mcc 1 1 — — $14,485.00 $14,485.00 $14,485.00 2026-04-14
253 MS_DRG Other Vascular Procedures With Cc 1 1 — — $14,485.00 $14,485.00 $14,485.00 2026-04-14
247 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent Without Mcc 1 1 — — $14,485.00 $14,485.00 $14,485.00 2026-04-14
254 MS_DRG Other Vascular Procedures Without Cc/mcc 1 1 — — $14,485.00 $14,485.00 $14,485.00 2026-04-14
246 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar… 1 1 — — $14,485.00 $14,485.00 $14,485.00 2026-04-14
244 MS_DRG Permanent Cardiac Pacemaker Implant Without Cc/mcc 1 1 — — $14,485.00 $14,485.00 $14,485.00 2026-04-14
243 MS_DRG Permanent Cardiac Pacemaker Implant With Cc 1 1 — — $14,485.00 $14,485.00 $14,485.00 2026-04-14
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 1 1 — — $14,485.00 $14,485.00 $14,485.00 2026-04-14
248 MS_DRG Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent With Mcc Or 4… 1 1 — — $14,485.00 $14,485.00 $14,485.00 2026-04-14
C9770 HCPCS Vitrec/mech Pars, Subret Inj 1 1 — — $13,461.00 $13,461.00 $13,461.00 2026-04-14
C9771 HCPCS Nsl/sins Cryo Post Nasal Tis 1 1 — — $13,461.00 $13,461.00 $13,461.00 2026-04-14
788 MS_DRG Cesarean Section Without Sterilization Without Cc/mcc 1 1 — — $12,053.00 $12,053.00 $12,053.00 2026-04-14
786 MS_DRG Cesarean Section Without Sterilization With Mcc 1 1 — — $12,053.00 $12,053.00 $12,053.00 2026-04-14
787 MS_DRG Cesarean Section Without Sterilization With Cc 1 1 — — $12,053.00 $12,053.00 $12,053.00 2026-04-14
785 MS_DRG Cesarean Section With Sterilization Without Cc/mcc 1 1 — — $12,053.00 $12,053.00 $12,053.00 2026-04-14
783 MS_DRG Cesarean Section With Sterilization With Mcc 1 1 — — $12,053.00 $12,053.00 $12,053.00 2026-04-14
784 MS_DRG Cesarean Section With Sterilization With Cc 1 1 — — $12,053.00 $12,053.00 $12,053.00 2026-04-14
419 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. Without Cc/mcc 1 1 — — $10,715.00 $10,715.00 $10,715.00 2026-04-14
418 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Cc 1 1 — — $10,715.00 $10,715.00 $10,715.00 2026-04-14
417 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Mcc 1 1 — — $10,715.00 $10,715.00 $10,715.00 2026-04-14
286 MS_DRG Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc 1 1 — — $8,385.00 $8,385.00 $8,385.00 2026-04-14
287 MS_DRG Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc 1 1 — — $8,385.00 $8,385.00 $8,385.00 2026-04-14
81416 CPT Exome Sequence Analysis 2 2 — — $5,454.00 $10,800.00 $8,127.00 2026-04-14
C7562 HCPCS Catheter Placement In Coronary Artery(s) For Coronary Angiography, Including Int… 2 1 — — $6,016.00 $9,621.00 $7,818.50 2026-04-14
C8005 HCPCS Bronchoscopy, Rigid Or Flexible, Non-thermal Transbronchial Ablation Of Lesion(s… 2 1 — — $5,511.00 $8,814.00 $7,162.50 2026-04-14
913T OTHER Percutaneous Transcatheter Therapeutic Drug Delivery By Intracoronary Drug-deliv… 2 1 — — $5,511.00 $8,814.00 $7,162.50 2026-04-14
915T OTHER Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co… 2 1 — — $5,511.00 $8,814.00 $7,162.50 2026-04-14
C7563 HCPCS Transluminal Balloon Angioplasty (except Lower Extremity Artery(ies) For Occlusi… 2 1 — — $5,511.00 $8,814.00 $7,162.50 2026-04-14
933T OTHER Transcatheter Implantation Of Wireless Left Atrial Pressure Sensor For Long-term… 2 1 — — $5,511.00 $8,814.00 $7,162.50 2026-04-14
C7564 HCPCS Percutaneous Transluminal Mechanical Thrombectomy, Vein(s), Including Intraproce… 2 1 — — $5,511.00 $8,814.00 $7,162.50 2026-04-14
36837 CPT Prq Av Fstl Crt Uxtr Sep Acs 4 3 — — $5,454.00 $8,814.00 $6,905.50 2026-04-14
36836 CPT Prq Av Fstl Crtj Uxtr 1 Acs 4 3 — — $5,454.00 $8,814.00 $6,905.50 2026-04-14
C9790 HCPCS Kidney Histotripsy W/image 3 2 — — $4,192.00 $13,250.53 $6,768.00 2026-04-14
806 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Cc 1 1 — — $6,721.00 $6,721.00 $6,721.00 2026-04-14
796 MS_DRG Vaginal Delivery With Sterilization And/or D&c With Mcc 1 1 — — $6,721.00 $6,721.00 $6,721.00 2026-04-14
807 MS_DRG Vaginal Delivery Without Sterilization Or D&c Without Cc/mcc 1 1 — — $6,721.00 $6,721.00 $6,721.00 2026-04-14
798 MS_DRG Vaginal Delivery With Sterilization And/or D&c Without Cc/mcc 1 1 — — $6,721.00 $6,721.00 $6,721.00 2026-04-14
805 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Mcc 1 1 — — $6,721.00 $6,721.00 $6,721.00 2026-04-14
797 MS_DRG Vaginal Delivery With Sterilization And/or D&c With Cc 1 1 — — $6,721.00 $6,721.00 $6,721.00 2026-04-14
93530 CPT Insertion Of Catheter Into Right Upper Heart Chamber For Evaluation Of Congenita… 2 2 — — $5,454.00 $7,786.00 $6,620.00 2026-04-14
93533 CPT Insertion Of Catheter Into Right And Left Heart Chambers Through Existing Septal… 2 2 — — $5,454.00 $7,786.00 $6,620.00 2026-04-14
93531 CPT Insertion Of Catheter Into Right And Left Heart Chambers For Evaluation Of Conge… 2 2 — — $5,454.00 $7,786.00 $6,620.00 2026-04-14
93532 CPT Insertion Of Catheter Into Right And Left Heart Chambers Through Intact Septum F… 2 2 — — $5,454.00 $7,786.00 $6,620.00 2026-04-14
981T OTHER Transcatheter Implantation Of Wireless Inferior Vena Cava Sensor For Long-term H… 2 1 — — $4,928.00 $7,879.00 $6,403.50 2026-04-14
81552 CPT Onc Uveal Mlnma Mrna 15 Gene 2 2 — — $5,454.00 $6,998.40 $6,226.20 2026-04-14
81529 CPT Onc Cutan Mlnma Mrna 31 Gene 2 2 — — $5,454.00 $6,473.70 $5,963.85 2026-04-14
C9901 HCPCS Endoscopic Defect Closure Within The Entire Gastrointestinal Tract, Including Up… 3 2 — — $3,683.00 $8,300.00 $5,946.00 2026-04-14
93624 CPT Electrophysiologic Study 5 3 — — $3,683.00 $6,631.00 $5,821.00 2026-04-14
93620 CPT Electrophysiology Evaluation 6 3 — — $0.50 $8,814.00 $5,666.00 2026-04-14
93619 CPT Electrophysiology Evaluation 6 3 — — $0.50 $8,814.00 $5,666.00 2026-04-14
93600 CPT Bundle Of His Recording 8 3 — — $0.50 $8,814.00 $5,482.50 2026-04-14
93618 CPT Heart Rhythm Pacing 8 3 — — $0.50 $8,814.00 $5,482.50 2026-04-14
920T OTHER Removal Of A Permanent Cardiac Contractility Modulation-defibrillation System Co… 2 1 — — $4,192.00 $6,768.00 $5,480.00 2026-04-14
917T OTHER Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co… 2 1 — — $4,192.00 $6,768.00 $5,480.00 2026-04-14
922T OTHER Removal Of A Permanent Cardiac Contractility Modulation-defibrillation System Co… 2 1 — — $4,192.00 $6,768.00 $5,480.00 2026-04-14
918T OTHER Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co… 2 1 — — $4,192.00 $6,768.00 $5,480.00 2026-04-14
888T OTHER Histotripsy (ie, Non-thermal Ablation Via Acoustic Energy Delivery) Of Malignant… 2 1 — — $4,192.00 $6,768.00 $5,480.00 2026-04-14
919T OTHER Removal Of A Permanent Cardiac Contractility Modulation-defibrillation System Co… 2 1 — — $4,192.00 $6,768.00 $5,480.00 2026-04-14
921T OTHER Removal Of A Permanent Cardiac Contractility Modulation-defibrillation System Co… 2 1 — — $4,192.00 $6,768.00 $5,480.00 2026-04-14
C7565 HCPCS Repair Of Anterior Abdominal Hernia(s) (ie, Epigastric, Incisional, Ventral, Umb… 2 1 — — $4,192.00 $6,768.00 $5,480.00 2026-04-14
C8003 HCPCS Implantation Of Medial Knee Extraarticular Implantable Shock Absorber Spanning T… 2 1 — — $4,192.00 $6,768.00 $5,480.00 2026-04-14
90476 CPT Adenovirus Vaccine Type 4 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90371 CPT Hep B Ig IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90644 CPT Hib-mency Vacc 6wk-18m0 IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90291 CPT Cmv Ig IV 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90472 CPT Immunization Admin Each Add 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90624 CPT Meningococcal Pentavalent Vaccine, Men B-4c Recombinant Proteins And Outer Membr… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90647 CPT Hib Prp-omp Vacc 3 Dose IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90632 CPT Hepa Vaccine Adult IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90626 CPT Tic-brn Enceph Vac 0.25ml IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90634 CPT Hepa Vacc Ped/adol 3 Dose 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77316 CPT Brachytx Isodose Plan Simple 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90480 CPT Admn Sarscov2 Vacc 1 Dose 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90630 CPT Flu Vacc Iiv4 No Preserv Id 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90638 CPT Influenza Virus Vaccine, Quadrivalent (qIRV), Mrna; 60 Mcg/0.5 Ml Dosage, For In… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90648 CPT Hib Prp-t Vaccine 4 Dose IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87467 CPT Hepatitis B Surface Ag Quan 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87469 CPT Babesia Microti Amp Prb 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90623 CPT Menacwy-tt Menb-fhbp Vacc IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
84394 CPT Tau, Total (tTau) 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80333 CPT Antidepressants Class 3-5 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80342 CPT Antipsychotics Nos 1-3 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
84393 CPT Tau, Phosphorylated (eg, pTau 181, pTau 217), Each 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
88749 CPT Unlisted In Vivo Lab Service 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90635 CPT Influenza Virus Vaccine, H5n1, Derived From Cell Cultures, Adjuvanted, For Intra… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80337 CPT Tricyclic & Cyclicals 6/more 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80340 CPT Antiepileptics Nos 4-6 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87468 CPT Anaplsma Phgcytophlm Amp Prb 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
86042 CPT Acetylcholn Rcptr Blckg Antb 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87450 CPT Immunologic Analysis For Detection Of Organism By Immunoassay Technique, Single … 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
86849 CPT Immunology Procedure 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87484 CPT Ehrlicha Chaffeensis Amp Prb 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90477 CPT Adenovirus Vaccine Type 7 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77306 CPT Telethx Isodose Plan Simple 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81517 CPT Liver Ds Alys 3 Bmrk Srm Alg 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87478 CPT Borrelia Miyamotoi Amp Prb 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90625 CPT Cholera Vaccine Live Oral 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
88099 CPT Unlisted Necropsy (autopsy) 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90471 CPT Immunization Admin 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90287 CPT Botulinum Antitoxin 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81449 CPT So Neo Gsap 5-50 RNA Alys 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87564 CPT Infectious Agent Detection By Nucleic Acid (dna Or Rna); Mycobacterium Tuberculo… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80344 CPT Antipsychotics Nos 7/more 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81479 CPT Unlisted Molecular Pathology 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87594 CPT Infectious Agent Detection By Nucleic Acid (dna Or Rna); Pneumocystis Jirovecii,… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80346 CPT Benzodiazepines1-12 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87513 CPT Infectious Agent Detection By Nucleic Acid (dna Or Rna); Helicobacter Pylori (h.… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90384 CPT Rh Ig Full-dose IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
82166 CPT Assay Anti-mullerian Horm 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90581 CPT Anthrax Vaccine Sc Or IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90622 CPT Vaccinia Vrs Vac 0.3 Ml Perq 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
84433 CPT Asy Thiopurin S-mthyltrnsfrs 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90649 CPT 4vhpv Vaccine 3 Dose IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90650 CPT 2vhpv Vaccine 3 Dose IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80343 CPT Antipsychotics Nos 4-6 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90284 CPT Human Ig Sc 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90382 CPT Respiratory Syncytial Virus, Monoclonal Antibody, Seasonal Dose, 0.7 Ml, For Int… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80322 CPT Alcohols Biomarkers 3/more 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
69715 CPT Removal Of Mastoid Bone With Implantation Of Cochlear Stimulating System, Access… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
83884 CPT Neurofilament Light Chain (NfL) 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90633 CPT Hepa Vacc Ped/adol 2 Dose IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90654 CPT Flu Vacc Iiv3 No Preserv Id 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90655 CPT Iiv3 Vacc No Prsv 0.25 Ml IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90656 CPT Iiv3 Vacc No Prsv 0.5 Ml IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90611 CPT Smallpox&monkeypox Vac 0.5ml 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90612 CPT Influenza Virus Vaccine, Trivalent, And Severe Acute Respiratory Syndrome Corona… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90621 CPT Menb-fhbp Vacc 2/3 Dose IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90375 CPT Rabies Ig Im/sc 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90613 CPT Influenza Virus Vaccine, Quadrivalent, And Severe Acute Respiratory Syndrome Cor… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90619 CPT Menacwy-tt Vaccine IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90627 CPT Tic-brn Enceph Vac 0.5ml IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
63199 CPT Removal Of Spine Bone With Incision Of Middle Spinal Cord, 2 Stages Within 14 Da… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
63195 CPT Removal Of Spine Bone With Incision Of One Middle Spinal Cord Tract 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80350 CPT Cannabinoids Synthetic 1-3 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80359 CPT Methylenedioxyamphetamines 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80373 CPT Drug Screening Tramadol 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
82233 CPT Beta-amyloid; 1-40 (Abeta 40) 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90620 CPT Menb-4c Vacc 2 Dose IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90636 CPT Hep A/hep B Vacc Adult IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80348 CPT Drug Screening Buprenorphine 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80502 CPT Comprehensive, Clinical Pathology Consultation 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81558 CPT Transplantation Medicine (allograft Rejection, Kidney), Mrna, Gene Expression Pr… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80345 CPT Drug Screening Barbiturates 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
62330 CPT Decomp. Perc. Incl. Laminotomy; Epidurography And Imaging; Bilat 1 Interspace Lu… 1 1 $8,637.00 $2,331.99 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
62163 CPT Removal Of Foreign Material In Brain Using An Endoscope 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80364 CPT Opioid &opiate Analog 5/more 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81459 CPT So Neo Gsap Dna/dna&rna 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
84999 CPT Unlisted Chemistry Procedure 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
61870 CPT Implantation Of Brain Neurostimulator Electrodes 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
62331 CPT Decomp. Perc. Incl. Laminotomy; Epidurography And Imaging; Bilat Addtl; Interspa… 1 1 $8,637.00 $2,331.99 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
80324 CPT Drug Screen Amphetamines 1/2 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80369 CPT Skeletal Muscle Relaxant 1/2 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
15850 CPT Removal Of Sutures Under Anesthesia By Same Surgeon 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
61715 CPT Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS), Ster… 3 2 — — $3,683.00 $5,946.00 $5,454.00 2026-04-14
80368 CPT Sedative Hypnotics 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
19366 CPT Plastic Surgery To Reconstruct Breast With Other Technique 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
63180 CPT Removal Of Upper Spine Bone With Removal Of Ligaments, 1 Or 2 Segments 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80351 CPT Cannabinoids Synthetic 4-6 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80358 CPT Drug Screening Methadone 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
63182 CPT Removal Of Upper Spine Bone With Removal Of Ligaments, More Than 2 Segments 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
63194 CPT Removal Of Spine Bone With Incision Of One Upper Spinal Cord Tract 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
63196 CPT Removal Of Spine Bone With Incision Of Both Upper Spinal Cord Tracts 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
63198 CPT Removal Of Spine Bone With Incision Of Upper Spinal Cord, 2 Stages Within 14 Day… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90376 CPT Rabies Ig Heat Treated 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81599 CPT Unlisted Maaa 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80500 CPT Clinical Pathology Consultation 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80349 CPT Cannabinoids Natural 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90593 CPT Chikungunya Virus Vaccine, Recombinant, For Intramuscular Use 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90589 CPT Chikungunya Vaccine Live IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90377 CPT Rabies Ig Ht&sol Human Im/sc 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81195 CPT Cytogenomic (genome-wide) Analysis, Hematologic Malignancy, Structural Variants … 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
64627 CPT Cervical Or Throacic Facet Radiofrequency/additional Level 64627 1 1 $2,458.00 $663.66 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
64626 CPT Cervical Or Throacic Facet Radiofrequency/1st Level 64626 1 1 $5,181.00 $1,398.87 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
66683 CPT Implantation Of Iris Prosthesis, Including Suture Fixation And Repair Or Removal… 3 2 — — $4,728.00 $7,411.00 $5,454.00 2026-04-14
69605 CPT Revision Of Previous Mastoid Surgery, With Removal Of A Portion Of The Temporal … 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
69718 CPT Removal Of Mastoid Bone With Removal And Replacement (Accessed Through The Skin)… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80330 CPT Analgesics Non-opioid 3-5 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80321 CPT Alcohols Biomarkers 1or 2 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
15013 CPT Preparation Of Skin Cell Suspension Autograft, Requiring Enzymatic Processing, M… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
15014 CPT Preparation Of Skin Cell Suspension Autograft, Requiring Enzymatic Processing, M… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80329 CPT Analgesics Non-opioid 1 Or 2 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80323 CPT Alkaloids Nos 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80347 CPT Benzodiazepines 13 Or More 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80328 CPT Anabolic Steroid 3 Or More 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80325 CPT Amphetamines 3or 4 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80327 CPT Anabolic Steroid 1 Or 2 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80326 CPT Amphetamines 5 Or More 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80334 CPT Antidepressants Class 6/more 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80341 CPT Antiepileptics Nos 7/more 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80331 CPT Analgesics Non-opioid 6/more 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80332 CPT Antidepressants Class 1 Or 2 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80335 CPT Antidepressant Tricyclic 1/2 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80336 CPT Antidepressant Tricyclic 3-5 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80339 CPT Antiepileptics Nos 1-3 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80338 CPT Antidepressant Not Specified 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80353 CPT Drug Screening Cocaine 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
86043 CPT Acetylcholn Rcptr Modlg Antb 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
85999 CPT Unlisted Hematology&coagj Px 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
86041 CPT Acetylcholn Rcptr Bndng Antb 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80354 CPT Drug Screening Fentanyl 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
86153 CPT Cell Enumeration Phys Interp 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
86366 CPT Muscle-specific Kinase Antb 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
86581 CPT Streptococcus Pneumoniae Antibody (IgG), Serotypes, Multiplex Immunoassay, Quant… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77293 CPT Respirator Motion Mgmt Simul 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
15171 CPT Acellular Dermal Replacement Trunk 100 Sq/cm Or Less 15170 1 1 $2,069.00 $558.63 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
15175 CPT Acellular Dermal Replacement Facial/genitalia/hands/feet 15175 1 1 $2,069.00 $558.63 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
90296 CPT Diphtheria Antitoxin 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
59618 CPT Attempted Vbac Delivery 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77307 CPT Telethx Isodose Plan Cplx 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77317 CPT Brachytx Isodose Intermed 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77318 CPT Brachytx Isodose Complex 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
59614 CPT Vbac Care After Delivery 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81451 CPT Hl Neo Gsap 5-50 RNA Alys 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81441 CPT Ibmfs Seq Alys Pnl 30 Genes 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
59622 CPT Attempted Vbac After Care 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
20926 CPT Tissue Grafts-other (eg. Paratenon/ Fat/dermis) 20926 1 1 $3,711.00 $1,001.97 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
80355 CPT Gabapentin Non-blood 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77399 CPT Unlisted Px Med Radj Physics 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77387 CPT Guidance For Radj Tx Dlvr 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77522 CPT Proton Trmt Simple W/comp 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81457 CPT So Neo Gsap DNA Mcrstl Ins 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77425 CPT Io Rad Tx Deliver By Elctrns 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77424 CPT Io Rad Tx Delivery By X-ray 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81458 CPT So Gsap DNA Cpy Nmbr&mcrstl 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77520 CPT Proton Trmt Simple Without Comp 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77469 CPT Io Radiation Tx Management 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77499 CPT Unlisted Px Ther Rad Tx Mgmt 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77523 CPT Proton Trmt Intermediate 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77525 CPT Proton Treatment Complex 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87523 CPT Hepatitis D Quantification 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87593 CPT Orthopoxvirus Amp Prb Each 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77771 CPT Hdr Rdncl Ntrstl/icav Brchtx 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77770 CPT Hdr Rdncl Ntrstl/icav Brchtx 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77772 CPT Hdr Rdncl Ntrstl/icav Brchtx 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80320 CPT Drug Screen Quantalcohols 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90585 CPT Bcg Vaccine Percut 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
59510 CPT Cesarean Delivery 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
59515 CPT Cesarean Delivery 3 2 — — $4,728.00 $7,411.00 $5,454.00 2026-04-14
80371 CPT Stimulants Synthetic 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
59425 CPT Antepartum Care Only 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
59426 CPT Antepartum Care Only 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
59610 CPT Vbac Delivery 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90281 CPT Human Ig IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90586 CPT Bcg Vaccine Intravesical 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90587 CPT Dengue Vacc Quad 3 Dose Subq 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90658 CPT Iiv3 Vaccine Splt 0.5 Ml IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80367 CPT Drug Screening Propoxyphene 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
58293 CPT Vaginal Removal Of Uterus (Greater Than 250 Grams) With Repair For Stress Incont… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90378 CPT Rsv Mab IM 50mg 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
55882 CPT Ablation Of Prostate Tissue, Transurethral, Using Thermal Ultrasound, Including … 3 2 — — $3,683.00 $5,946.00 $5,454.00 2026-04-14
57112 CPT Complete Removal Of Vaginal Wall And Surrounding Tissue With Removal Of Lymph No… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87626 CPT Infectious Agent Detection By Nucleic Acid (dna Or Rna); Human Papillomavirus (h… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90631 CPT Influenza Virus Vaccine (iiv), H5, Pandemic Formulation, Split Virus, Adjuvanted… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
19324 CPT Breast Enlargement Without A Prosthesis 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
55711 CPT Biopsy Prostate; Transrectal Mri/us Guided; 1st Targeted Lesion 55711 1 1 $4,529.00 $1,222.83 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
80362 CPT Opioids & Opiate Analogs 1/2 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
55707 CPT Biopsy Prostate Transrectal U/s Guided 55707 1 1 $4,300.00 $1,161.00 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
55708 CPT Biopsy Prostate; Transrectal Us/mri Guidance First Lesion 55708 1 1 $4,300.00 $1,161.00 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
80375 CPT Drug/substance Nos 1-3 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90288 CPT Botulism Ig IV 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90637 CPT Influenza Virus Vaccine, Quadrivalent (qIRV), Mrna; 30 Mcg/0.5 Ml Dosage, For In… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49656 CPT Repair Of Incisional Hernia Using An Endoscope, Recurrent Of Secondary 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49655 CPT Repair Of Trapped Incisional Hernia Using An Endoscope, Primary 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49657 CPT Repair Of Trapped Incisional Hernia Using An Endoscope, Secondary 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49652 CPT Repair Of Hernia Using An Endoscope 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49653 CPT Repair Of Trapped Hernia Using An Endoscope 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
53865 CPT Cystourethroscopy With Insertion Of Temporary Device For Ischemic Remodeling (ie… 3 2 — — $3,683.00 $5,946.00 $5,454.00 2026-04-14
59135 CPT Removal Impregnated Ovum Outside The Uterus And Entire Uterus 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49570 CPT Repair Of Not Trapped Incisional Or Abdominal Hernia, In The Upper Stomach Area 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49568 CPT Placement Of Mesh To Repair Incisional Or Abdominal Hernia, Open Procedure 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49572 CPT Repair Of Trapped Incisional Or Abdominal Hernia In The Upper Stomach Area 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49565 CPT Repair Of Incisional Or Abdominal Hernia, Recurrent Of Secondary, Not Trapped 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49561 CPT Repair Of Trapped Incisional Or Abdominal Hernia 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49566 CPT Repair Of Trapped Recurrent Incisional Or Abdominal Hernia 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49580 CPT Repair Of Hernia At Navel Patient Younger Than Age 5 Years 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49585 CPT Repair Of Hernia At Navel Patient Age 5 Years Or Older 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49587 CPT Repair Of Trapped Hernia At Navel Patient Age 5 Years Or Older 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
22851 CPT Application Interverteral Device 22851 1 1 $8,637.00 $2,331.99 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
49590 CPT Repair Of Hernia Between Abdominal Muscles 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49654 CPT Repair Of Incisional Hernia Using An Endoscope, Initial Or Primary 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49190 CPT Excision Or Destruction, Open, Intra-abdominal (ie, Peritoneal, Mesenteric, Retr… 3 2 — — $3,683.00 $5,946.00 $5,454.00 2026-04-14
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